HomeMy WebLinkAboutS2019-0118 - Permit ApplicationA4WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY
BUOILDINGDOIVISION BEACH S2.0 -&I($
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRAC
2. DESCRIPTION OF WORK -tII'V Y-6 66.5 -b 1, �— �%�/� tt
tM (n ESTIMATED $ VALU�"%"
TION 1✓ E�!
SWIMMING POOL L� SPA L� POOL FENCING [:1 Stiff
Check Aaorooriate box for Annlicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
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LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
Pm AA l-eA `i2ls'oq
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. 1 ON +) Clas�J
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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,E USE ONL�
PERMIT . Cl
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POOL P/C FEE $
DRAINAGE P/C FEE $
Forces\Pool spa app] (rev3-04).xls
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